This could be the year local power prevails

A motto for 2008? Rein in the quango state. Bring the local back into government. Make most public services - particularly health and policing - accountable to strengthened town and county halls. Let the best councils oversee primary and acute health. Break down, or scrap, police authorities and hand their powers to councils at command unit level. Formally scrutinise those unaccountable government agencies and higher education institutions. In short, take central government at its word. Join up services in a way that will always elude Whitehall. Seize the higher social and economic ground.

It is no longer a tall order. Interviewed recently by Society Guardian, the communities and local government secretary, Hazel Blears, was clear that the future lay in councils sharing budgets, as well as performance indicators, with, say, local health trusts. "It is our responsibility as ministers to unblock any difficulties there are," she volunteered. If only it could be so easy.

We have long learned that ministerial pronouncements are one thing; delivering seamless services on the ground are quite another. As 2007 was drawing to a close, the scale of the task facing those anxious to deliver joined-up, accountable and efficient services - let's call them local democrats - became clear.

Sir Simon Milton, the Conservative chair of the Local Government Association (LGA), had just delivered a lecture in which he called for a new movement to reinvigorate democracy, based on Gordon Brown's call back in June for a new constitutional settlement. Milton rightly detected the emergence of a cross-party consensus over the limits of centralism. "The solutions to some of society's greatest challenges will only be found locally ... issues on a human scale that require treatment, advice or mentoring, and [require] a fundamental understanding of the community within which they exist," he declared.

Noting the prime minister's call for greater accountability over health and policing, and making clear he was not a devolution fundamentalist - "some powers [organised crime and national security, for instance] are properly held at the national level", Milton called for every local service, such as neighbourhood policing, to be directly accountable to local people through their councils.

And for policing, read health. One council has already become a pace-setter. Herefordshire has just become the first authority with a single chief executive covering both the council and the primary care trust (PCT). Milton says the next logical step involves bringing together the governance arrangements "of these separate elements of the local state." Blears would undoubtedly agree. But will the Department of Health move in this democratic direction while, at the same time, allowing the PCT to pool its budget with a council? Blears says she will act as the Whitehall "enforcer" to bang heads together where necessary. This could be her first test.

But be warned, the NHS establishment is already mobilising against this democratic onslaught. Its first line of attack is always to equate local democracy with "political control"; ie: it prefers anonymous central direction to local people questioning the service they receive. Perish the thought. The NHS Confederation, responding to Milton, thundered: "There is little evidence of any public appetite for changing the accountability mechanisms in the NHS. There is, however, evidence that the public have more faith in local clinicians than in their local councillors."

Arrogant? Insensitive? Or out of touch? Many of us have had intensive experience of the NHS - good, bad, indifferent - directly and indirectly. We can draw our own conclusions. Meanwhile, a resurgent LGA has launched an independent commission to examine the NHS. Good work!